Thorax deel 1
Wat moeten we kennen?
A. De student onderbouwt de techniek van Dit onderdeel bestaat uit 25 vragen.
medisch beeldvormende onderzoeken en
radiotherapeutische behandeling van de
thorax en vaten
B. De student benoemt anatomische- en Dit onderdeel bestaat uit 20 vragen.
pathologische structuren en fysiologische
processen bij medisch beeldvormende
onderzoeken van de thorax en vaten.
C. De student bewerkt en verwerkt Dit onderdeel bestaat uit 8 vragen.
verkregen medische beelden en
bestralingsplannen
D. De student herkent en benoemt culturele Dit onderdeel bestaat uit 4 vragen.
factoren die de communicatie
beïnvloeden.
E. De student kent de verschillende coping Dit onderdeel bestaat uit 3 vragen.
stijlen van patiënten bij het omgaan met
ziek zijn.
, Pagina |2
Inhoudsopgave
Thorax met focus op tractus respiratorius ................................................................................................................ 7
Regulatie van de ademhaling .................................................................................................................................11
stellingen ...................................................................................................................................................................11
Tractus respiratorius Pathologie ...............................................................................................................................12
Terminologie............................................................................................................................................................12
Typische symptomen luchtwegaandoeningen ...............................................................................................12
Casus → dyspneu....................................................................................................................................................12
Differentiaal diagnose 1.....................................................................................................................................12
Differentiaal diagnose 2.....................................................................................................................................15
Oncologie en oncogenese ..........................................................................................................................................16
oncologie ..................................................................................................................................................................16
Gradering .............................................................................................................................................................16
Stagering...............................................................................................................................................................16
Stadiëring .............................................................................................................................................................17
Oncogenese .............................................................................................................................................................17
De normale Celcyclus ........................................................................................................................................17
Oncogenese .........................................................................................................................................................18
Tumorheterogeniteit ..........................................................................................................................................18
Tumorprogressie en resistentie ........................................................................................................................19
Oorzaken mutaties..................................................................................................................................................19
Erfelijkheid ..........................................................................................................................................................19
Omgevingsfactoren ............................................................................................................................................19
Leeftijd .................................................................................................................................................................19
Insteltechniek Thorax .................................................................................................................................................20
Instelkunde staand PA ...........................................................................................................................................20
Positionering .......................................................................................................................................................20
Centrering ............................................................................................................................................................20
Criteria..................................................................................................................................................................20
Instelkunde staand lateraal ....................................................................................................................................21
Positionering .......................................................................................................................................................21
Centrering ............................................................................................................................................................21
Criteria..................................................................................................................................................................21
Instelkunde AP in bed............................................................................................................................................21
positionering........................................................................................................................................................21
Criteria..................................................................................................................................................................21
Thorax deel 1 Thema 5 Romée Coster
, Pagina |3
Lordotic view ...........................................................................................................................................................22
Variabele parameters ..............................................................................................................................................22
Strooistralenrooster ............................................................................................................................................22
Buisspanning (kV) ..............................................................................................................................................22
PA opname..........................................................................................................................................................22
Laterale opname .................................................................................................................................................23
Focus detector afstand ......................................................................................................................................23
Meetvelden ..........................................................................................................................................................23
Buisfiltering .........................................................................................................................................................23
Beeldherkenning X thorax .........................................................................................................................................24
Terminologie............................................................................................................................................................24
Pathologie.................................................................................................................................................................26
Pneumonie...........................................................................................................................................................26
Fissuren en lobben .............................................................................................................................................26
TBC – de tering ..................................................................................................................................................26
C.O.P.D, Chronic Obstructive Pulmonary Disease .....................................................................................26
Astma ...................................................................................................................................................................27
Pneumothorax, klaplong ...................................................................................................................................27
Pleuravocht..........................................................................................................................................................27
CTR ......................................................................................................................................................................27
Decompensatio cordis, hartfalen .....................................................................................................................28
Skelet ....................................................................................................................................................................28
Mediastinum ........................................................................................................................................................28
MRI.......................................................................................................................................................................29
Maligniteiten ........................................................................................................................................................29
Metastasen ...........................................................................................................................................................29
Longembolie .......................................................................................................................................................29
Thorax techniek spatiële resolutie en temporele resolutie – coCT1 ...................................................................30
Instelling CT Thorax standaard ............................................................................................................................30
Instelling CT Thorax HRCT .................................................................................................................................30
Spatiële resolutie definitie ......................................................................................................................................31
Beeldmatrix .........................................................................................................................................................31
Field of view........................................................................................................................................................32
Coupedikte ..........................................................................................................................................................32
Kernel ...................................................................................................................................................................32
Temporele resolutie definitie ................................................................................................................................33
Thorax deel 1 Thema 5 Romée Coster
, Pagina |4
Werking en beeldvorming op de MRI .....................................................................................................................34
De Magneet..............................................................................................................................................................34
Nettomagnetisatie Vector (Mz) ............................................................................................................................34
Effect 1 → longitudinale magnetisatie naar beneden ...................................................................................35
Effect 2 → ontstaan van transversale magnetisatie ......................................................................................35
Signaal .......................................................................................................................................................................35
Relaxaties ..................................................................................................................................................................35
Samenvatting ...........................................................................................................................................................36
Werking en beeldvorming op de MRI deel 2..........................................................................................................37
Repetitietijd (TR) ....................................................................................................................................................37
Echotijd (TE) ..........................................................................................................................................................37
Klinische contrastwegingen...................................................................................................................................37
Contrastmiddelen ...............................................................................................................................................38
Klinische toepassing ...............................................................................................................................................38
Transducers ..................................................................................................................................................................39
Piëzo-elektrisch effect ............................................................................................................................................39
Compound-scanning ..............................................................................................................................................39
Mechanische transducers .......................................................................................................................................40
Elektronische transducers .....................................................................................................................................40
Thorax in de NG .........................................................................................................................................................41
Principes ...................................................................................................................................................................41
Perfusie....................................................................................................................................................................41
Ventilatie .................................................................................................................................................................41
Statische acquisitie ..................................................................................................................................................41
Statische acquisitie ..................................................................................................................................................41
100 MBq 99m Tc MAA .........................................................................................................................................41
… MBq 81m kr-gas ................................................................................................................................................41
LEHR .......................................................................................................................................................................41
MEAP .......................................................................................................................................................................41
Matrix: 128 x 128 ....................................................................................................................................................41
Matrix: 128 x 128 ....................................................................................................................................................41
Teltijd: 500000 cts ...................................................................................................................................................41
Teltijd: 500000 cts ...................................................................................................................................................41
Zittend positioneren ...............................................................................................................................................41
Zittend positioneren ...............................................................................................................................................41
Views: Ant, LPO, Post en RPO ...........................................................................................................................41
Thorax deel 1 Thema 5 Romée Coster
Wat moeten we kennen?
A. De student onderbouwt de techniek van Dit onderdeel bestaat uit 25 vragen.
medisch beeldvormende onderzoeken en
radiotherapeutische behandeling van de
thorax en vaten
B. De student benoemt anatomische- en Dit onderdeel bestaat uit 20 vragen.
pathologische structuren en fysiologische
processen bij medisch beeldvormende
onderzoeken van de thorax en vaten.
C. De student bewerkt en verwerkt Dit onderdeel bestaat uit 8 vragen.
verkregen medische beelden en
bestralingsplannen
D. De student herkent en benoemt culturele Dit onderdeel bestaat uit 4 vragen.
factoren die de communicatie
beïnvloeden.
E. De student kent de verschillende coping Dit onderdeel bestaat uit 3 vragen.
stijlen van patiënten bij het omgaan met
ziek zijn.
, Pagina |2
Inhoudsopgave
Thorax met focus op tractus respiratorius ................................................................................................................ 7
Regulatie van de ademhaling .................................................................................................................................11
stellingen ...................................................................................................................................................................11
Tractus respiratorius Pathologie ...............................................................................................................................12
Terminologie............................................................................................................................................................12
Typische symptomen luchtwegaandoeningen ...............................................................................................12
Casus → dyspneu....................................................................................................................................................12
Differentiaal diagnose 1.....................................................................................................................................12
Differentiaal diagnose 2.....................................................................................................................................15
Oncologie en oncogenese ..........................................................................................................................................16
oncologie ..................................................................................................................................................................16
Gradering .............................................................................................................................................................16
Stagering...............................................................................................................................................................16
Stadiëring .............................................................................................................................................................17
Oncogenese .............................................................................................................................................................17
De normale Celcyclus ........................................................................................................................................17
Oncogenese .........................................................................................................................................................18
Tumorheterogeniteit ..........................................................................................................................................18
Tumorprogressie en resistentie ........................................................................................................................19
Oorzaken mutaties..................................................................................................................................................19
Erfelijkheid ..........................................................................................................................................................19
Omgevingsfactoren ............................................................................................................................................19
Leeftijd .................................................................................................................................................................19
Insteltechniek Thorax .................................................................................................................................................20
Instelkunde staand PA ...........................................................................................................................................20
Positionering .......................................................................................................................................................20
Centrering ............................................................................................................................................................20
Criteria..................................................................................................................................................................20
Instelkunde staand lateraal ....................................................................................................................................21
Positionering .......................................................................................................................................................21
Centrering ............................................................................................................................................................21
Criteria..................................................................................................................................................................21
Instelkunde AP in bed............................................................................................................................................21
positionering........................................................................................................................................................21
Criteria..................................................................................................................................................................21
Thorax deel 1 Thema 5 Romée Coster
, Pagina |3
Lordotic view ...........................................................................................................................................................22
Variabele parameters ..............................................................................................................................................22
Strooistralenrooster ............................................................................................................................................22
Buisspanning (kV) ..............................................................................................................................................22
PA opname..........................................................................................................................................................22
Laterale opname .................................................................................................................................................23
Focus detector afstand ......................................................................................................................................23
Meetvelden ..........................................................................................................................................................23
Buisfiltering .........................................................................................................................................................23
Beeldherkenning X thorax .........................................................................................................................................24
Terminologie............................................................................................................................................................24
Pathologie.................................................................................................................................................................26
Pneumonie...........................................................................................................................................................26
Fissuren en lobben .............................................................................................................................................26
TBC – de tering ..................................................................................................................................................26
C.O.P.D, Chronic Obstructive Pulmonary Disease .....................................................................................26
Astma ...................................................................................................................................................................27
Pneumothorax, klaplong ...................................................................................................................................27
Pleuravocht..........................................................................................................................................................27
CTR ......................................................................................................................................................................27
Decompensatio cordis, hartfalen .....................................................................................................................28
Skelet ....................................................................................................................................................................28
Mediastinum ........................................................................................................................................................28
MRI.......................................................................................................................................................................29
Maligniteiten ........................................................................................................................................................29
Metastasen ...........................................................................................................................................................29
Longembolie .......................................................................................................................................................29
Thorax techniek spatiële resolutie en temporele resolutie – coCT1 ...................................................................30
Instelling CT Thorax standaard ............................................................................................................................30
Instelling CT Thorax HRCT .................................................................................................................................30
Spatiële resolutie definitie ......................................................................................................................................31
Beeldmatrix .........................................................................................................................................................31
Field of view........................................................................................................................................................32
Coupedikte ..........................................................................................................................................................32
Kernel ...................................................................................................................................................................32
Temporele resolutie definitie ................................................................................................................................33
Thorax deel 1 Thema 5 Romée Coster
, Pagina |4
Werking en beeldvorming op de MRI .....................................................................................................................34
De Magneet..............................................................................................................................................................34
Nettomagnetisatie Vector (Mz) ............................................................................................................................34
Effect 1 → longitudinale magnetisatie naar beneden ...................................................................................35
Effect 2 → ontstaan van transversale magnetisatie ......................................................................................35
Signaal .......................................................................................................................................................................35
Relaxaties ..................................................................................................................................................................35
Samenvatting ...........................................................................................................................................................36
Werking en beeldvorming op de MRI deel 2..........................................................................................................37
Repetitietijd (TR) ....................................................................................................................................................37
Echotijd (TE) ..........................................................................................................................................................37
Klinische contrastwegingen...................................................................................................................................37
Contrastmiddelen ...............................................................................................................................................38
Klinische toepassing ...............................................................................................................................................38
Transducers ..................................................................................................................................................................39
Piëzo-elektrisch effect ............................................................................................................................................39
Compound-scanning ..............................................................................................................................................39
Mechanische transducers .......................................................................................................................................40
Elektronische transducers .....................................................................................................................................40
Thorax in de NG .........................................................................................................................................................41
Principes ...................................................................................................................................................................41
Perfusie....................................................................................................................................................................41
Ventilatie .................................................................................................................................................................41
Statische acquisitie ..................................................................................................................................................41
Statische acquisitie ..................................................................................................................................................41
100 MBq 99m Tc MAA .........................................................................................................................................41
… MBq 81m kr-gas ................................................................................................................................................41
LEHR .......................................................................................................................................................................41
MEAP .......................................................................................................................................................................41
Matrix: 128 x 128 ....................................................................................................................................................41
Matrix: 128 x 128 ....................................................................................................................................................41
Teltijd: 500000 cts ...................................................................................................................................................41
Teltijd: 500000 cts ...................................................................................................................................................41
Zittend positioneren ...............................................................................................................................................41
Zittend positioneren ...............................................................................................................................................41
Views: Ant, LPO, Post en RPO ...........................................................................................................................41
Thorax deel 1 Thema 5 Romée Coster
